(*1). Florence Nightingale School of Nursing and Midwifery, King’s College London, London SE1 8WA, UK (*2). Department of Primary Care and Public Health Sciences, King’s College London, London SE1 3QD

Correspondence To : C Humphrey

charlotte.humphrey@kcl.ac.uk

Accepted on : 01 February 2011

Abstract

Objectives : To evaluate whether country of medical qualification is associated with “higher impact” decisions at different stages of the UK General Medical Council’s (GMC’s) “fitness to practise” process after allowing for other characteristics of doctors and inquiries.

Design : Retrospective cohort study.

Setting : Medical practice in the United Kingdom.

Participants : 7526 inquiries to the GMC concerning 6954 doctors.

Main Outcome Measures : Proportion of inquiries referred for further investigation at initial triage by the GMC, proportion of inquiries investigated that were subsequently referred for adjudication, and proportion of inquiries resulting in doctors being erased or suspended from the medical register; relative odds of higher impact decisions, by country of qualification, adjusted for doctors’ sex, years since primary medical qualification, medical specialty, source and type of inquiry, and nature of allegations.

Results : Of 7526 inquiries, 4702 concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the European Union (EU), and 2190 concerned doctors who qualified outside the EU. At the initial triage, 30% (n=1398) of inquiries concerning doctors who qualified in the UK had a high impact decision, compared with 43% (267) for doctors who qualified elsewhere in the EU and 46% (998) for those who qualified outside the EU. The adjusted relative odds of an inquiry being referred for further investigation were 1.67 (95% confidence interval 1.28 to 2.17) for doctors who qualified elsewhere in the EU and 1.61 (1.38 to 1.88) for those who qualified outside the EU, compared with doctors who qualified in the UK. At the investigation stage, 5% (228) of inquiries received concerning UK qualified doctors were referred for adjudication, compared with 10% for EU (63) or non-EU (221) qualified doctors. The adjusted relative odds of referral for adjudication were 2.14 (1.46 to 3.16) for doctors who qualified elsewhere in the EU and 1.68 (1.31 to 2.16) for those who qualified outside the EU. At the adjudication stage, 1% (69) of inquiries received concerning UK qualified doctors led to erasure or suspension, compared with 4% (24) for doctors who qualified elsewhere in the EU and 3% (71) for non-EU qualified doctors. The adjusted relative odds of erasure or suspension were 2.16 (1.22 to 3.80) for doctors who qualified elsewhere in the EU and 1.48 (1.00 to 2.19) for those who qualified outside the EU.

Conclusions : Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded.

* Immediately Strip the GMC (General Medical Council) of it's Exclusive Right to Refer Cases to the MPTS. This can easily be done by ensuring that the MPTS ethically follows a Similar Fashion to the Stellar Model of the Solicitors Disciplinary Tribunal ; thus allowing the MPTS TO READILY ACCEPT DIRECT REFERRALS FROM THE GENERAL PUBLIC , THE MEDICAL PROFESSION , AND THE MEDICAL REGULATORS (Subject to an Impartial MPTS Evidential Test).

Nearly 1,600 of Britain’s brightest students have been asked to leave medical degrees or have dropped out in the past five years, costing the taxpayer millions.

Data from more than 30 medical schools, released under freedom of information laws, reveals that nearly 1,200 British students, most with top grades at A-level, left with no qualification.

Others changed course or were awarded a BSc.

One expert spoke of an “epidemic” of mental health problems among students and said more support was needed. Another, Professor of education said: “This level of attrition is a terrible waste of public money as well as being desperately sad for the individuals concerned.”

It costs about £250,000 to Train a Doctor in the UK (at Basic Medical School Degree Level).

* Immediately Strip the GMC (General Medical Council) of it's Exclusive Right to Refer Cases to the MPTS. This can easily be done by ensuring that the MPTS ethically follows a Similar Fashion to the Stellar Model of the Solicitors Disciplinary Tribunal ; thus allowing the MPTS TO READILY ACCEPT DIRECT REFERRALS FROM THE GENERAL PUBLIC , THE MEDICAL PROFESSION , AND THE MEDICAL REGULATORS (Subject to an Impartial MPTS Evidential Test).

Nearly 1,600 of Britain’s brightest students have been asked to leave medical degrees or have dropped out in the past five years, costing the taxpayer millions.

Data from more than 30 medical schools, released under freedom of information laws, reveals that nearly 1,200 British students, most with top grades at A-level, left with no qualification.

Others changed course or were awarded a BSc.

One expert spoke of an “epidemic” of mental health problems among students and said more support was needed. Another, Professor of education said: “This level of attrition is a terrible waste of public money as well as being desperately sad for the individuals concerned.”

It costs about £250,000 to Train a Doctor in the UK (at Basic Medical School Degree Level).

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